Harbor:Legal

Risk Management

• RM is automatically notified when safety intelligence event (SI) is placed
• For any adverse events that warrant family/patient notification, the physician needs to do it
• RM at HUMC: Lan Soeur or Haya Nemtzov
  • x66330 or pgr x1277

Filming in the Hospital

Board of Supervisors County Filming Policy

OK to book

• Once the patient is medically cleared to be in custody, fill out the 'OK to book' form and give to law enforcement
• If the patient has an ongoing medical need, such as home O2 or dialysis, then contact the 'Medical Command Center' 213-893-5544 so arrangements can be made for continuing care (such as LAC+USC Jail ED/Ward)
• Contact AOD if issues, may need to escalate to Jail CMO, Dr. Henderson

Law Enforcement Requested Blood Draw

DHS and Harbor ED policy on Blood Draws Requested by Law Enforcement #4.3

Law Enforcement in the ED

• Any outside police agency can be directed to the HUMC Sheriffs for questions
  • In the event of a large law enforcement presence due to an officer involved incident, the HUMC Sheriffs Sergeant should be involved to direct vehicle and personnel traffic and keep the treatment areas clear

• Hospital Policy 451 - Outside Law Enforcement Agency Contact with Patients
  • In cases where law enforcement brings a patient to the hospital on a 5150 mental health/legal hold, the patient is to remain in the charge of the law enforcement officer until such time as a proper hand-off from law enforcement to the clinical team has occurred.
  • Section 5150 of the Welfare and Institution Code (WIC) authorizes peace officers to take an adult into custody if, in their opinion, the person meets the criteria set forth within this section. Section 5585.50 WIC authorizes peace officers to take minors into custody if a minor meets the criteria set forth within this section. Section 7325 WIC authorizes peace officers to apprehend and return, any escaped patient, who is involuntarily detained under 5150 WIC, upon written request by a representative designated in this section (Conservator). Section 5150.2 WIC stipulates that designated medical personnel must facilitate the safe and orderly transfer of physical custody of a person being held by law enforcement on a 5150 WIC hold.
  • All peace officers bringing any person in their custody into HUCLA must contact the on-site Sheriff’s office without delay. If the person in their custody is placed on a 5150 WIC hold, only the handling officer can transfer custody of that person to a qualified psychiatrist once the person is admitted into the Psychiatric Emergency Department. If the alleged mentally ill person requires medical attention, the transporting officer shall accompany the patient to the Emergency Room (ER) and shall remain with the patient until he or she has been medically cleared for admittance in the Psychiatric Emergency Department. Once the patient has been medically cleared, the officer will accompany the patient to the Psychiatric Emergency Department where the officer will securely transfer custody of the patient to a qualified psychiatrist. If the person in the officers’ custody is arrested or detained on a criminal offense, the handling officers are responsible for retaining custody indefinitely. It is not the responsibility of the on-site Sheriff’s personnel to assume custody, or assist in the retention of custody, of any person being held by any other law enforcement officer.

• HIPAA and Law Enforcement
  • It is acceptable to notify officers of the patient's status (stable/unstable), dispo (admit/DC), but you should not divulge health information details without a written consent by the patient
  • ACEP - Law Enforcement in the ED - great resource explaining patient's rights even when in custody
  • Bodycams/recording
    • Patients have a right to privacy - HIPAA is federal law
      • During your exam, you can ask officers to step outside of the room (as long as you feel comfortable/safe; otherwise, you may request they remain in the room with cameras off)
      • You, as the physician, have to consent to being recorded before they can record you
    • Officers can record for the purposes of investigation as long as they are not interfering with your medical care
    • Escalate any issues to our Sheriffs to liaise with outside law enforcement
      • If this does not resolve the situation, you can ask to speak with their watch commander or escalate to risk management (66330) who is available 24/7 (p1277)
      • If the medical situation is urgent and you cannot delay examination and treatment (EMTALA is federal law), professionally address the officer/bodycam: "Officer X, I am Dr. X; I am going to interview and examine MY patient; please step outside of the room/stop recording to ensure the confidentiality of my physician/patient relationship and not violate HIPAA."

• ICE Tips
  • Maintain usual practice environment and flow - do not alter your medical care, do not engage or impede ICE agents
  • Although ICE agents should only be in public spaces, the Department of Homeland Security rescinded the "sensitive areas" protections.
    • Do NOT physically interfere if the officer insists on gaining access to a sensitive area.
    • Do NOT actively assist the immigration enforcement officer.
    • Do NOT help anyone, hide, lie, or flee the area.
    • Do not video record any encounters
    • No social media posting with HUMC/DHS affiliation
    • Please do not hand any information that is not related to patient's medical care to patients in custody (even if requested)
  • Consider Rx pick-up from HUMC to provide to the patient prior to DC
• If you encounter an immigration officer attempting entry into a patient care space:
  • Notify the OCN who will contact:
    • Harbor’s Risk Management Office (66330, p1277); Risk Management will immediately notify DHS Risk Management and County Counsel.
    • Securitas should notify their supervisor immediately
    • The Sheriffs are our typical law enforcement liaisons
  • Call the Physician AOD (on ByteBloc)
    • File:SLP - Script and Incident Report Form.pdf
  • Provide the officer with a copy of the policy and ask if they have a warrant. File:MB NO. 25-02 - Los Angeles County Sensitive Locations Policy (ICE - Safe Spaces).pdf
    • If the officer has a warrant, obtain a copy, and provide to Harbor’s Risk Management; they will forward it to DHS Risk Management and County Counsel
    • If there is no warrant and the officer insists on entering a sensitive location, please tell them “The County does NOT consent” or “I am granting access under protest”.

• Sensitive Locations Policy
  • DHS Immigration and Sensitive Locations Policy Page
  • DHS Red Cards (printable in 20 languages)
  • County Policy 3.175
  • HUMC Policy 451 - Outside Law Enforcement Agency Contact with Patients
  • 1/24/2025 - Harbor-UCLA Management Bulletin 25-02
    • Board of Supervisors affirmed all county departments must comply with the California Values Act (SB 54) limiting the use of local resources for immigration enforcement and designating hospitals as "safe spaces"; under this direction, HUMC does not collaborate with ICE.
      • ICE is not welcome in any treatment space without a law enforcement warrant
  • File:ACEP Navigating Immigration Enforcement.pdf

EMTALA Concerns/Problem Transfers

• DHS Policy 309: Problem Transfer Report and Follow-up
  • Receiving HUMC ED physician forward concerns to Dr. Claudius or ED Chair within 24 hours
    • DO NOT DIRECTLY SUBMIT THE FORM TO THE EMS AGENCY OR HEALTH FACILITIES INSPECTION DIVISION
  • Dr. Claudius (the ED Designee) or Chair will email the Problem Transfer Form to risk management within 3 calendar days
    • Problem Transfer Form
  • Risk management will investigate and review the case

• HUMC Policy 451
  • Securitas provides orientation informational pamphlet, get visitor sticker (to differentiate from Harbor LASD staff)
    • Securitas calls HUMC LASD to check in outside LEP
    • Outside LEP then directed to OCN or Area Charge
    • OCN/Area Charge checks with physician if patient is stable for LEP interview
    • If patient it is not medically appropriate to have LEP interview the patient, please document in your note, communicate to LEP.
  • Patients NOT in custody
    • Patients who are NOT in LE custody have a right to refuse interviews and/or photographing by law-enforcement agencies.  (This policy does NOT apply to psychiatric patients on a hold; they are covered by different laws.)
  • Patients in custody
    • Harbor will provide emergency and stabilizing care to in-custody patients; when these patients are stable for transport, in accordance with EMTALA, they should be transferred to the LAC+USC Medical Center Jail Ward for continued care/treatment.
    • For critical patients who require emergent medical intervention and stabilization, law enforcement will remove the patient’s handcuffs, at the request of the attending physician.
    • Outside LE may be asked to leave the patient’s room during the patient care to ensure patient privacy and confidentiality, unless doing so would cause an unsafe situation.  The officer must remain in the immediate vicinity and keep the patient in view throughout the provision of medical care or treatment. 
    • Any requests by the patient’s family/friends to the clinical staff for contact with an in-custody patient shall be directed to the involved LE agency and/or Harbor Sheriff.
    • If any issues arise related to the presence and/or behavior of outside LE, staff should contact Harbor Sheriff for assistance. 
    • If outside LE fails to comply after discussion with Harbor Sheriff, the issue should be referred to Risk Management.
  • LE will be cleared to detain the patient once the full evaluation and urgent treatment of the patient are complete, and at the discretion of the ED or admitting attending physician.

Law Enforcement Escorting Patients Out Of the Emergency Department

Because of the potential conflicts with EMTALA law, it is important that a physician be involved in any decision to remove any patient or potential patient from the emergency department. For this reason, any time law enforcement is either requested by nursing staff, or decides on its own, to escort a patient from the emergency department (including the waiting room), an attending physician should be notified and agree with (and document) the decision. The House Supervisor should also be notified (x3434) before involving law enforcement. Documentation should specifically state that the patient has had a medical screening exam and does not have an emergency medical condition, or if there is an emergency medical condition that it has been appropriately stabilized. Obviously, it should also be safe for the patient to be removed from the emergency department.

Dir AED 5/26/16

Weapons in ED

• As a general rule, no patients should have weapons on them (INCLUDING PEACE OFFICERS), even if they have concealed weapons permit.
• No visitors should have weapons. The only exception to visitors carrying weapons are active peace officers.
• Patients and visitors are screened by Securitas with metal detectors at the front entrance of the S/E building and ambulance entrance.
  • If a patient is unstable and is rushed in, then once the patient is stabilized, Securitas will be contacted to then screen the patient and his/her belongings.
• If you encounter issues, call the Sheriffs Department for assistance.

ILLICIT DRUGS/MARIJUANA IN ED

• Marijuana less than an ounce (plant) or 8 gms (concentrate) and patient at least 21 years old - keep with patient belongings
• Marijuana quantity more than above (or not sure), or possessed by person under 21 - Call Sheriff
• All other illicit drugs (or suspect as illicit) - Call Sheriff

Family Viewing of Deceased Patients

If you have a death in the ED, please don't direct family to the morgue and don't promise body viewing. If the death is potentially a coroner's case, with an unclear cause of death or concerns for possible criminal activity (violence, hit and run, etc.), the family may not be allowed near the body for concerns of evidentiary integrity. For any death that we will be disclosing to the family, the ED social worker should be present to handle the details of discussing body and funeral preparations with the family.

Family Bereavement Resources

How to access the bereavement packet if needed.

• Go to home page for Harbor/UCLA and click on Departments/Site pages
• Once the page comes up, look in the second column for Patient Education
• Click on Patient Education
• Once the page comes up, look for Patient Handouts
• Click on Patient Handouts
• Once page comes up, scroll down to Bereavement packet; it is available in English, Spanish, and Korean.

OBSERVERS IN THE ED

• There can never be an observer of any type in the ED without the prior permission of hospital administration or the chair, or one of the vice-chairs in the department.
• Observers must be introduced to any patient whose care they observe and the patient must be given the opportunity, in a non-coercive and open manner, to not have the observer present during their care.
• Observers must never be present during sensitive parts of medical care (e.g., genital exams, during history taking regarding abuse or sexual assault, etc.).
• Observers must wear a clearly visible name tag that provides their first and last name and identifies them as an “Observer” or using a more descriptive label (e.g., “Medical Student” or “Residency Candidate”).

Chair, EM 9/2017

See Also

• Harbor:Main